| NPI | 1528037934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24066) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 2153) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2019-12-13 |