| NPI | 1386326460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12105) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2024-03-19 |