| NPI | 1205854130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19315) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017410) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |