| NPI | 1316945215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT015053) |
| Additional Taxonomies | 224L00000X Pedorthist (Licence: PA CPED2750) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2013-10-21 |