| NPI | 1033987409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031800) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: PA PT031800) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: PA PT031800) | |
| Enumeration Date | 2023-12-15 |
| Last Update Date | 2023-12-15 |