| NPI | 1972722676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT 001411E) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002654) |
| 225100000X Physical Therapist (Licence: NJ 40QA01378300) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2011-02-09 |