| NPI | 1316487911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL21203) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1276095) |
| Enumeration Date | 2017-03-01 |
| Last Update Date | 2025-10-16 |