| NPI | 1255999868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27470) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2020-01-02 |