| NPI | 1457541765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 022249-1) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: ME PT3301) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT23210) | |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2019-12-19 |