| NPI | 1659633105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19040) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: MA 19040) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MA 19040) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2012-06-11 |