| NPI | 1659129765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA CP048175T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NH 61503867) | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2025-07-29 |