| NPI | 1407151236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18503) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8487) |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2011-01-26 |