| NPI | 1427007061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT011189L) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: PA OC004210L) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2012-11-16 |