| NPI | 1043395007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MA 15110) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: CA 33177) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2019-10-21 |