| NPI | 1891793097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: PA DAPT002078) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA PT010009L) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2014-11-06 |