| NPI | 1841965209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031399) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL PT37526) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2023-12-20 |