| NPI | 1871239756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT030629) |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2025-02-12 |