| NPI | 1821084955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT012062L) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2009-02-25 |