| NPI | 1598137119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 2494) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 11368) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2015-10-22 |