| NPI | 1659348175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT007247L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26906) |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2024-07-01 |