| NPI | 1073744165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 005890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 5890) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2016-03-17 |