| NPI | 1386710820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007875) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17851) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2015-11-16 |