| NPI | 1114491131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024360) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA pt0243600) |
| Enumeration Date | 2019-01-12 |
| Last Update Date | 2022-05-18 |