| NPI | 1538684618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT034146) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003757) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2026-08-24 |