| NPI | 1720313547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021243) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1191668) |
| 225100000X Physical Therapist (Licence: NY 038242) | |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2021-10-20 |