| NPI | 1396755682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022688) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 23343) |
| 225100000X Physical Therapist (Licence: GA 009480) | |
| 225100000X Physical Therapist (Licence: TN 9356) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2013-06-19 |