| NPI | 1861463663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21134) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2012-10-04 |