| NPI | 1033521893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62 036836) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38611) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2020-01-13 |