| NPI | 1104802818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 7670) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 007670) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2022-03-04 |