| NPI | 1821259813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019315) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6856) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2019-02-28 |