| NPI | 1558747527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT027560) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15815) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2020-10-14 |