| NPI | 1811938228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT016155) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT000699) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2024-04-17 |