| NPI | 1003908906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 7136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI 822) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2018-06-21 |