| NPI | 1689829798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007902) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012651) |
| 225100000X Physical Therapist (Licence: NY 028448) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CT 007902) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2022-06-02 |