| NPI | 1568737039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT024008) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 38521) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2018-03-17 |