| NPI | 1396930434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT33941) |
| 225100000X Physical Therapist (Licence: FL 23670) | |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2009-04-01 |