| NPI | 1508841131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040-0003805) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 16964) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2014-02-17 |