| NPI | 1326409558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT004134) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2021-08-02 |