| NPI | 1003953001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3154) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2010-11-03 |