| NPI | 1215982418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: DE J1-0001437) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ CP050063T) |
| 225100000X Physical Therapist (Licence: MD CP029727T) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT016262) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2025-11-13 |