| NPI | 1982832630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18682) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15216) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2015-08-27 |