| NPI | 1891213344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 322480) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2018-10-09 |