| NPI | 1528220241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070019445) |
| 225100000X Physical Therapist (Licence: WA PT60023302) | |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2018-03-17 |