| NPI | 1003613670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT033026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 033026) |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2026-07-07 |