| NPI | 1871705814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017145) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01099200) |
| 225100000X Physical Therapist (Licence: CA 30043) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |