| NPI | 1669871604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 21328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 13432) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2023-04-10 |