| NPI | 1841487048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002167) |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2022-05-10 |