| NPI | 1962705699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT022782) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206422) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2016-10-18 |