| NPI | 1104178714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT021483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 10192) |
| 225100000X Physical Therapist (Licence: DE J1-0014449) | |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2022-03-15 |