| NPI | 1023016995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT000794) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT006278L) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2014-06-05 |