| NPI | 1407819006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT014190L) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT014190L) |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2023-11-08 |