| NPI | 1720158330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA pt015515) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: FL PT16987) |
| 222Q00000X Developmental Therapist (Licence: PA PT015515) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: PA PT015515) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-07-21 |