| NPI | 1467149021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031080) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1374547) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2023-04-24 |