| NPI | 1841433679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: CT 008122) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MA 17904) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CT 008122) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2012-01-23 |