| NPI | 1811947955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 5200) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2016-04-27 |