| NPI | 1942261300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 9020) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 948) |
| 2251S0007X Physical Therapist, Sports (Licence: RI 948) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2025-03-18 |