| NPI | 1477544062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT002226L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1135168) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2009-06-30 |