| NPI | 1992256523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 22396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 292135) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2021-12-29 |