| NPI | 1629716139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030648) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT023510) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2023-11-03 |