| NPI | 1427504166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19244) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025267) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-08-25 |