| NPI | 1053183020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT031585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA TX61505966) |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2024-07-09 |