| NPI | 1760614895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT008944L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA PTL28116) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2025-03-31 |