| NPI | 1932552544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT022085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT872012) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2019-07-02 |