| NPI | 1346555893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025268) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-017979) |
| 225100000X Physical Therapist (Licence: NC P16011) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2016-12-07 |