| NPI | 1356570295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020061) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34578) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2022-09-07 |