| NPI | 1841578929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021280) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24017) |
| 225100000X Physical Therapist (Licence: DE J1-0002725) | |
| Enumeration Date | 2011-07-24 |
| Last Update Date | 2019-12-13 |