| NPI | 1588403091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032515) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: PA TPT023830) |
| Enumeration Date | 2024-05-23 |
| Last Update Date | 2025-01-29 |