| NPI | 1023180551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 29030) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 024733) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2021-04-14 |