| NPI | 1275784381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 0008306) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2013-02-22 |