| NPI | 1396184032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 2868) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 13122) |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2013-06-16 |