| NPI | 1164434981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 2674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 15760) |
| 225100000X Physical Therapist (Licence: PA PT011311L) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-09 |