| NPI | 1376729806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3296) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2013-04-19 |