| NPI | 1518716067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032308) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216415) |
| Enumeration Date | 2024-05-16 |
| Last Update Date | 2024-05-30 |