| NPI | 1417258856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT002756) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT020931) |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2019-10-15 |