| NPI | 1053999623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029244) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-034246) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2025-11-10 |