| NPI | 1154643815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305206033) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2021-08-02 |