| NPI | 1508112632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022758) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24119) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2020-10-06 |