| NPI | 1760480131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 9751) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2218) |
| 225100000X Physical Therapist (Licence: NY 014739) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2023-09-15 |