| NPI | 1578853131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19248) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4247) |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2018-10-09 |