| NPI | 1811245376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT003071) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022281) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2014-11-10 |