| NPI | 1396000998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL20174) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: MA AT1646) |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-02-06 |