| NPI | 1316656119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0014597) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2022-11-21 |