| NPI | 1639545874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029105) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15838) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2021-01-29 |