| NPI | 1154406502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT013116L) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT013116L) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2024-04-22 |