| NPI | 1790239051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025515) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003910) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2021-04-15 |