| NPI | 1356636484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023505) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23342) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2016-08-10 |