| NPI | 1639779952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL27647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013970A) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2024-10-16 |