| NPI | 1770209702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 26806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT39406) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2023-05-18 |