| NPI | 1245503309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT002430) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT007104L) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2018-04-12 |