| NPI | 1760732424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 3138) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 2421) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2012-09-10 |