| NPI | 1194264184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT025877) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT025877) |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2020-09-14 |