| NPI | 1033270681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT026501) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NY 024410) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2018-04-03 |