| NPI | 1699112011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 5221) |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2013-05-24 |