| NPI | 1538898259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL26810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-5679) |
| 225100000X Physical Therapist (Licence: VT 040.0134562) | |
| 225100000X Physical Therapist (Licence: DC PT210002410) | |
| 225100000X Physical Therapist (Licence: NY 048745) | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2024-09-12 |