| NPI | 1619253077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18992) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38213) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2011-10-31 |