| NPI | 1225614837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P21101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029176) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2022-03-24 |