| NPI | 1154716934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: PA OT021545) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 23052009002) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-02-22 |