| NPI | 1093795932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015710) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT000214) |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2019-02-22 |