| NPI | 1649905779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL88904) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: CO CP049695T) | |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2025-09-24 |