| NPI | 1467852129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25293) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023965) |
| Enumeration Date | 2014-09-01 |
| Last Update Date | 2020-11-30 |