| NPI | 1538838321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27526) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046549) |
| 225100000X Physical Therapist (Licence: VA 2305214738) | |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2024-10-02 |