| NPI | 1275005126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27759) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2021-04-27 |