| NPI | 1952852501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025579) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003567) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2017-01-20 |