| NPI | 1245778695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025837) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-4857) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2024-04-22 |