| NPI | 1649235169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT001134) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT001451E) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-08 |