| NPI | 1376085134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23305) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60752702) |
| 225100000X Physical Therapist (Licence: NY 040450-1) | |
| Enumeration Date | 2016-11-10 |
| Last Update Date | 2021-05-24 |