| NPI | 1801275896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 003468) |
| Enumeration Date | 2015-05-22 |
| Last Update Date | 2021-10-27 |