| NPI | 1356157465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27971) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 11210) |
| 225100000X Physical Therapist (Licence: NC P22430) | |
| Enumeration Date | 2024-12-04 |
| Last Update Date | 2024-12-04 |