| NPI | 1982080438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26140) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024466) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2022-04-14 |