| NPI | 1922585231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VT 040.0003406) |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: VT 040.0003406) |
| 2251S0007X Physical Therapist Sports (Licence: NY 02210) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: NY 022210) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2018-07-20 |