| NPI | 1134552128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028929) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24588) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2020-09-25 |