| NPI | 1205374642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT025835) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003789) |
| Enumeration Date | 2017-02-06 |
| Last Update Date | 2019-11-07 |