| NPI | 1841647336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT029678) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: PA DC011152) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2025-11-20 |