| NPI | 1457585945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024763) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA PT024763) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2021-08-18 |