| NPI | 1720414816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: MA 20708) |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2023-08-09 |