| NPI | 1316457393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23576) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MA 636162) | |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2022-08-10 |