| NPI | 1982892949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT014202L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10002270) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2015-03-12 |