| NPI | 1356460299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT005218L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT001179) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2015-07-20 |