| NPI | 1437151941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 14225) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT016746) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2007-07-08 |