| NPI | 1205451069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031265) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-31337) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2023-08-09 |