| NPI | 1487799953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT000078) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT015498) |
| 225100000X Physical Therapist (Licence: FL PT16730) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |