| NPI | 1629071998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT-000807E) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: DE J1-0001844) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2008-04-15 |