| NPI | 1902870744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT PT002233) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CT P00368) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2010-08-03 |