| NPI | 1578273322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 27957) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: GA PT016129) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2024-09-04 |