| NPI | 1932183233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 1086) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 15882) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2024-01-23 |