| NPI | 1952338337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0001883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21348) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2013-09-19 |