| NPI | 1083382873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MA 000025728) | |
| Enumeration Date | 2021-09-06 |
| Last Update Date | 2024-03-19 |