| NPI | 1457758757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 023595) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003306) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2014-12-02 |