| NPI | 1437897147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030537) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2025-01-24 |