| NPI | 1770969594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0134153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 296407) |
| 225100000X Physical Therapist (Licence: NH 4003) | |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2021-08-02 |