| NPI | 1235503970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 13141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 2380) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |