| NPI | 1669952602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11946) |
| Enumeration Date | 2018-08-20 |
| Last Update Date | 2023-09-21 |