| NPI | 1093779332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT01385L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6758) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2013-10-01 |