| NPI | 1588639322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 27695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT008081L) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2025-01-14 |