| NPI | 1639654528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025687) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: PA F03947) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2024-11-05 |