| NPI | 1639374556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VT 040-0003719) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 03444-1) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2007-07-15 |