| NPI | 1205815784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018509) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20812) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2017-02-17 |