| NPI | 1366850497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT028319) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT29374) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2023-01-05 |