| NPI | 1376877290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 17798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3202) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2024-02-28 |