| NPI | 1770745465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027777) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5753) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2024-05-21 |