| NPI | 1073596755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 019911) |
| 225100000X Physical Therapist (Licence: MA 15690) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2012-11-09 |