| NPI | 1134476450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023486) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24112) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2014-07-25 |