| NPI | 1144659616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH PT2553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 2553) |
| 225100000X Physical Therapist (Licence: MA 13117) | |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2018-04-11 |