| NPI | 1285678292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT009920L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT001369) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-03-12 |