| NPI | 1144733791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030247) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26771) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2023-12-29 |