| NPI | 1316048630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2006007055) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2022-02-03 |