| NPI | 1851306153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 11612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 0400003612) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2017-12-04 |