| NPI | 1144201658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT001256E) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: PA PT001256E) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT001256E) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2015-01-20 |