| NPI | 1477220556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MN 13225) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03465) |
| 225100000X Physical Therapist (Licence: NH 4894) | |
| 225100000X Physical Therapist (Licence: MA 26131) | |
| 225100000X Physical Therapist (Licence: ME PT6038) | |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2023-07-28 |