| NPI | 1356831606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028286) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE JT-0000961) |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2021-12-30 |