| NPI | 1750335766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016271) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA PTO16271) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2013-03-14 |