| NPI | 1366190902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT030296) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-09-03 |