| NPI | 1669112124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030465) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PENDING) |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2023-07-03 |