| NPI | 1033543475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41803) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036187) |
| Enumeration Date | 2013-08-21 |
| Last Update Date | 2025-02-06 |