| NPI | 1184007080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24255) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14.010633) |
| Enumeration Date | 2015-07-09 |
| Last Update Date | 2019-07-18 |