| NPI | 1891084091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT021165) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT002778) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2020-08-27 |