| NPI | 1407854474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT003548L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA AH18744PT) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2010-05-03 |