| NPI | 1487998779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023444) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6891) |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2020-10-07 |