| NPI | 1487937827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021651) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13958) |
| Enumeration Date | 2011-09-22 |
| Last Update Date | 2021-05-25 |