| NPI | 1649233388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016146) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD CP031330T) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2024-06-10 |