| NPI | 1114986510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20374) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017248) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-09-30 |