| NPI | 1134770845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027988) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19161) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2021-03-04 |