| NPI | 1003027608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4457) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 10814) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-07-11 |