| NPI | 1033543004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036850) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1359362) |
| Enumeration Date | 2013-08-27 |
| Last Update Date | 2022-08-05 |