| NPI | 1649281858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 19260) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-11-14 |