| NPI | 1942244850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0001576) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015144) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2011-06-13 |