| NPI | 1831608371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23186) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8779) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2019-02-12 |