| NPI | 1285769943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MA 512) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NH 0159) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |