| NPI | 1659071785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031097) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P23712) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2025-04-18 |