| NPI | 1043396872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 17780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT09462) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2025-09-11 |