| NPI | 1831814839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL89523) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 39065) |
| Enumeration Date | 2022-10-11 |
| Last Update Date | 2026-06-04 |