| NPI | 1003031816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015918) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20500) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2016-02-17 |