| NPI | 1477048965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23647) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: MA 23647) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2020-11-11 |