| NPI | 1467051243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030807) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1336096) |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2023-02-06 |