| NPI | 1053508630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT018940) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA PT018940) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2021-05-21 |