| NPI | 1679128714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT028034) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT028034) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2021-11-16 |