| NPI | 1427277599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MA PA4280) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 17458) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2020-08-10 |