| NPI | 1821125568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0087580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5555) |
| 225100000X Physical Therapist (Licence: NY 0274541) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2023-09-05 |