| NPI | 1538601547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027224) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31921) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2026-01-27 |