| NPI | 1225038300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA DAPT000647) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT009189L) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2022-08-26 |