| NPI | 1487691168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015799) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007444L) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2024-02-26 |