| NPI | 1336511757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22128) |
| Enumeration Date | 2015-10-25 |
| Last Update Date | 2024-07-09 |