| NPI | 1578612206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT010361L) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: PA PT010361L) |
| 225100000X Physical Therapist (Licence: PA PT-010361-L) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2011-02-01 |