| NPI | 1023488376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62039132) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2023-11-28 |