| NPI | 1730723719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213301) |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2020-10-16 |