| NPI | 1902885619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT0106821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-016821-L) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2022-12-15 |