| NPI | 1205366119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL88755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26455) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2025-09-18 |