| NPI | 1518217314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DE J1-0014536) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT022296) |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2024-10-07 |