| NPI | 1700481504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028732) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014272) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2020-12-18 |