| NPI | 1790413714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT030652) |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2022-11-18 |