| NPI | 1073915666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 12204PT) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036910-1) |
| 225100000X Physical Therapist (Licence: NJ 40QA01539700) | |
| 225100000X Physical Therapist (Licence: MA 20731) | |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2016-05-25 |