| NPI | 1285915546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 21577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03515) |
| 225100000X Physical Therapist (Licence: GA PT012175) | |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2024-11-11 |