| NPI | 1134197312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OT014320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019688) |
| 208D00000X General Practice (Licence: OH 34.013572CTR) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2019-12-19 |