| NPI | 1275552499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT013719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT01858) |
| 225100000X Physical Therapist (Licence: MA 18093) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2019-10-29 |