| NPI | 1750625307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19083) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 27099) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2018-06-29 |