| NPI | 1811414865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4950) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2022-07-21 |