| NPI | 1972935674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 22785) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207097) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2018-12-20 |