| NPI | 1437432598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022547) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206973) |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2013-05-31 |