| NPI | 1073704680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 5226) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2019-08-30 |