| NPI | 1275051013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23670) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA PT293580) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2019-07-08 |