| NPI | 1336423318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT002937) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2026-02-17 |