| NPI | 1235342643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: ME PT3292) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 22300) |
| 225100000X Physical Therapist (Licence: MA 17755) | |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: FL AL 1851) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2010-02-24 |