| NPI | 1578695557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17444) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2007-07-16 |