| NPI | 1750156956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14282) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 27263) |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2024-06-26 |