| NPI | 1801104161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020936) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36272) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2012-07-06 |