| NPI | 1619944121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21290) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MD 0170368) |
| 146N00000X Emergency Medical Technician, Basic (Licence: PA 110751) | |
| 225100000X Physical Therapist (Licence: PA PT019655) | |
| Enumeration Date | 2006-03-02 |
| Last Update Date | 2022-04-28 |