| NPI | 1144636200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: PA PT024936) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2020-02-19 |