NPI | 1871011882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT026382) |
Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: PA PT026382) |
225100000X Physical Therapist (Licence: NJ 40QA01752700) | |
Enumeration Date | 2017-08-30 |
Last Update Date | 2018-09-27 |