| NPI | 1013961341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT030126) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA00453100) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2022-01-31 |