| NPI | 1184694564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT013857L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA DAPT000658) |
| 2251S0007X Physical Therapist, Sports (Licence: PA PT013857L) | |
| 2251S0007X Physical Therapist, Sports (Licence: PA DAPT000658) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT013857L) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PA DAPT000658) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2013-08-13 |