| NPI | 1063637387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16502) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: MA 5041) |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2007-07-08 |