| NPI | 1881251585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12178) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24093) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |