| NPI | 1649430638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10002368) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2025-07-21 |