| NPI | 1831342047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 15267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4413) |
| 225100000X Physical Therapist (Licence: FL 23366) | |
| 225100000X Physical Therapist (Licence: GA PT007500) | |
| Enumeration Date | 2008-10-31 |
| Last Update Date | 2008-10-31 |