| NPI | 1487345427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22221) |
| Enumeration Date | 2023-05-19 |
| Last Update Date | 2025-02-05 |