| NPI | 1639255417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18938) |
| 225100000X Physical Therapist (Licence: NH 3505) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2015-10-01 |