| 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 |