| NPI | 1104673623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 5507) |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2025-04-29 |