| NPI | 1447033030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL88804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14191) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2026-06-16 |