| NPI | 1801889852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT-009525-L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT-1132) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2008-05-02 |