| NPI | 1366647703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018889) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10002272) |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2014-09-17 |