| NPI | 1194061853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT017233) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT005491) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2022-12-29 |