| NPI | 1649528506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023465) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27430) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2022-04-05 |