| NPI | 1740573278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 9067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9067) |
| 225X00000X Occupational Therapist (Licence: CT 9067) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2011-05-17 |