| NPI | 1851886824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 4360) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0131467) |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2023-12-04 |