| NPI | 1134233398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018523) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1 - 0001975) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2014-01-15 |