| NPI | 1649636150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024982) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT021767) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2016-02-23 |