| NPI | 1366411266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT 012726L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10002211) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2014-09-17 |