| NPI | 1144695214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 22342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039571-1) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2016-08-16 |