| NPI | 1194158121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023056) |
| Enumeration Date | 2013-08-13 |
| Last Update Date | 2013-09-26 |