| NPI | 1780631077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT013499L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0001501) |
| 225100000X Physical Therapist (Licence: MD 25733) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2019-10-28 |