| NPI | 1285796318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3278) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21988) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-09-23 |