| NPI | 1184956484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 21510) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 8742) |
| Enumeration Date | 2010-02-11 |
| Last Update Date | 2015-06-12 |