| NPI | 1811223985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19255) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PT 10558) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2014-07-22 |