| NPI | 1164657441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020143) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT002499) |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2025-10-24 |