| NPI | 1962451427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 10157) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 22296) |
| 225100000X Physical Therapist (Licence: HI 1842) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2012-11-01 |