| NPI | 1770075301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027832) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251S0007X Physical Therapist, Sports (Licence: PA PT027832) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-05-03 |