| NPI | 1053627794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH NH-3690) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 19163) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2016-06-03 |