| NPI | 1588342299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PTO031333) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014723) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-07-11 |