NPI | 1730521485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024795) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24255) |
Enumeration Date | 2013-07-23 |
Last Update Date | 2022-03-10 |