| NPI | 1245893809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027192) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: DE J1-0003968) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2019-04-29 |