| NPI | 1225698376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028062) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT023291) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2025-04-28 |