| NPI | 1457769515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT023785) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT023785) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2019-09-12 |