| NPI | 1124374384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024454) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9419) |
| 225100000X Physical Therapist (Licence: PA DAPT003261) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2015-08-14 |