| NPI | 1154909232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PT26182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT36970) |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2024-04-09 |