| NPI | 1144575143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027343) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13731) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2021-06-09 |