| NPI | 1710964556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT003608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305202353) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2017-01-19 |