| NPI | 1346295714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007813) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17390) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-12-21 |