| NPI | 1073270146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048840) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25883) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2022-07-13 |