| NPI | 1417909664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015803) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT001137) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-11-09 |