| NPI | 1164038626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL28030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0020379) |
| 225100000X Physical Therapist (Licence: CT 12791) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2025-02-06 |