| NPI | 1265904213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014248) |
| 225100000X Physical Therapist (Licence: NC P18491) | |
| Enumeration Date | 2018-12-31 |
| Last Update Date | 2022-04-01 |