| NPI | 1215171228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18130) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292706) |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2021-04-12 |