| NPI | 1366790461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022083) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD PT24187) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2020-07-23 |