| NPI | 1205468170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028387) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014445) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2023-03-14 |