| NPI | 1447520390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24832) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033989) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2020-11-18 |