| NPI | 1366438525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT007106L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAT 000020) |
| 225100000X Physical Therapist (Licence: FL PT31417) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2026-07-13 |