| NPI | 1730151762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist Sports (Licence: MA 15342) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2021-01-21 |