| NPI | 1225699754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33619) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2019-06-25 |