| NPI | 1740248681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: PA PT018008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018008) |
| 2255A2300X Specialist/Technologist Athletic Trainer (Licence: PA RT003422) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2016-08-11 |