| NPI | 1306411079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 19724) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 13064) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |