| NPI | 1427118306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT0002796L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PT0002796L) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2012-04-06 |