| NPI | 1821420605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: PA PT022854) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT022854) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2024-07-14 |