| NPI | 1710606553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26277) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2022-08-24 |