| NPI | 1336464122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040-0003741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3415) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2010-04-05 |