| NPI | 1841724531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028467) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 5010) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-10-23 |