| NPI | 1356672885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020331) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3703) |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2010-01-22 |