| NPI | 1679015317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 27709) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040433) |
| Enumeration Date | 2016-11-11 |
| Last Update Date | 2024-07-24 |