| NPI | 1326074212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT008384L) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 17847) |
| 225100000X Physical Therapist (Licence: DE J10001538) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: DE J1-0001538) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: PA 008384) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-01-12 |