| NPI | 1184238388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 13298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25120) |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2021-09-22 |