| NPI | 1326515958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029093) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT6573) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2021-02-09 |