| NPI | 1770232605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030427) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28868) |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2022-07-05 |