| NPI | 1174306195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT034304) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014755) |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2026-08-24 |