| NPI | 1073903621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024194) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT021616) |
| Enumeration Date | 2015-02-03 |
| Last Update Date | 2015-02-05 |