| NPI | 1568757920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021311) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27889) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2020-03-11 |