| NPI | 1760726459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023602) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207685) |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2015-05-10 |