| NPI | 1831572007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025109) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT011960) |
| Enumeration Date | 2015-07-06 |
| Last Update Date | 2016-06-16 |