| NPI | 1639112493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PTO18231) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10001784) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-05-02 |