| NPI | 1841397429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040-0003606) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VT 040.0003606) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2018-03-17 |