| NPI | 1194792440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: VT 0400061031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0226101) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2010-03-19 |