| NPI | 1679719918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 17622) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34965) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2015-12-07 |