| NPI | 1528368586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 06379) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18956) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2010-10-25 |