| NPI | 1346824836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25470) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 012324) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2021-05-28 |