| NPI | 1346379872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015785) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT23126) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2019-10-09 |