| NPI | 1548459688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18490) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2015-10-07 |