| NPI | 1548386261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 8477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17519) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2019-04-18 |