| NPI | 1659723393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042312-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0124005) |
| 225100000X Physical Therapist (Licence: NH 4111) | |
| 225100000X Physical Therapist (Licence: MA 22214) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2020-04-16 |