| NPI | 1871622233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL22955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27040) |
| 225100000X Physical Therapist (Licence: GA PT012719) | |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2026-05-07 |