| NPI | 1861775710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021645) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT002878) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2022-11-14 |