| NPI | 1114983400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT017555) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA DAPT001539) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2015-03-09 |