| NPI | 1720730310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031713) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 37956) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2023-09-05 |