| NPI | 1164528899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT009781L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT009781) |
| 225100000X Physical Therapist (Licence: PA DAPT000302) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2022-04-12 |