| NPI | 1598278962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL23378) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA 23378) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2023-07-27 |