| NPI | 1407822901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT004083L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT000360) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2016-04-25 |