| NPI | 1952683047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 15137) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 2984) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2011-09-14 |