| NPI | 1407362593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029116) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23356) |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2021-05-17 |