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 |