| NPI | 1033767090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014520) |
| 225100000X Physical Therapist (Licence: PA PT027940) | |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2022-03-10 |