| NPI | 1629308218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206328) |
| Enumeration Date | 2010-01-05 |
| Last Update Date | 2015-04-28 |