| NPI | 1033239447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204971) |
| 225100000X Physical Therapist (Licence: MD 22819) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2013-02-18 |