| NPI | 1518172345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022518) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: FL 22088) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2020-04-07 |