| NPI | 1447765706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT004941) |
| 225100000X Physical Therapist (Licence: NY 042383-1) | |
| Enumeration Date | 2017-12-08 |
| Last Update Date | 2025-04-14 |