| NPI | 1528499597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 0400134115) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01527800) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2020-06-18 |