| NPI | 1508333741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: MA 23977) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23977) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2019-08-30 |