| NPI | 1093904989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 33883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028412-1) |
| 225100000X Physical Therapist (Licence: MA 17149) | |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2019-06-26 |