| NPI | 1790558583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031608) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P22728) |
| 225100000X Physical Therapist (Licence: SC 12085) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2025-02-03 |