| NPI | 1457550196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 002404) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT12206) |
| 2251X0800X Physical Therapist Orthopedic (Licence: CT 002404) | |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2018-03-17 |