| NPI | 1962607531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027226) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17573) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2021-03-27 |