| NPI | 1598036345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9292) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 19741) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2013-02-22 |