| NPI | 1982287751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT005244L) |
| 2251C2600X Physical Therapist, Cardiopulmonary (Licence: PA PT005244L) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: PA PT005244L) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT005244L) | |
| 225400000X Rehabilitation Practitioner (Licence: PA PT005244L) | |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2022-03-02 |