| NPI | 1013392109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42234) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037071) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2024-08-22 |