| NPI | 1346766896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4750) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23197) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2022-07-18 |