| NPI | 1467861542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027324) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 11050) |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2018-10-18 |