| NPI | 1972179653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213882) |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2022-11-28 |