| NPI | 1588814867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3371) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20460) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2013-04-09 |