| NPI | 1609075274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NH 18356) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: RI LP02592) |
| 225100000X Physical Therapist (Licence: ME PT3414) | |
| 225100000X Physical Therapist (Licence: MA 17919) | |
| 225100000X Physical Therapist (Licence: VT 0400003732) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2018-03-19 |