| NPI | 1871186791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 15663) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 005893) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2023-01-22 |