| NPI | 1518116433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3655) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0296571) |
| 225100000X Physical Therapist (Licence: MA 20026) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2015-09-21 |