| NPI | 1063151983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030709) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT023528) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2022-08-18 |