| NPI | 1962987172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24794) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16553) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2021-11-09 |