| NPI | 1659352797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016001) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17054) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2009-12-02 |