| NPI | 1255614822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023556) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 23760) |
| Enumeration Date | 2011-09-21 |
| Last Update Date | 2021-05-10 |