| NPI | 1609244185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4725) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2019-01-29 |