| NPI | 1093189755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 2961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 15879) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |