| NPI | 1619448636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL28258) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040383) |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2025-03-03 |