| NPI | 1114067477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 62029776) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA pt017897) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: PA rt003170) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-11-05 |