| NPI | 1033664982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31491) |
| 225100000X Physical Therapist (Licence: NY 041254) | |
| Enumeration Date | 2016-08-22 |
| Last Update Date | 2023-05-01 |