| NPI | 1780911479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002527) |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |