| NPI | 1689330920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH el07911) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25586) |
| Enumeration Date | 2021-11-10 |
| Last Update Date | 2021-11-10 |