| NPI | 1689020315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025030) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: FL 31259) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2022-07-21 |