| NPI | 1255370896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT005605L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT000665) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-06-09 |