| NPI | 1215246145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MA 27325) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2025-01-06 |