| NPI | 1255379137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT014289) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT014289) |
| 225100000X Physical Therapist (Licence: PA DAPT000225) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2021-01-26 |