| NPI | 1134149750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT011706L) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-08-14 |