| NPI | 1629680400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 13475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24996) |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2022-08-09 |