| NPI | 1578080321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23950) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4279) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2018-09-25 |