| NPI | 1659612703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019622) |
| 2251G0304X Physical Therapist, Geriatrics | |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2015-11-18 |