| NPI | 1164740494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 0400003317) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2010-05-11 |