| NPI | 1801023544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019957) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT109957) |
| Enumeration Date | 2009-06-21 |
| Last Update Date | 2021-03-15 |