| NPI | 1508054735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL10392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3283) |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2023-12-22 |