| NPI | 1851597439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3208) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17333) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2013-02-22 |