| NPI | 1467637009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017880) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0000721) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2008-10-13 |