| NPI | 1487124780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT026426) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1247159) |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2018-11-29 |