| NPI | 1235530106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0105604) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20735) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2014-09-10 |