| NPI | 1033679253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 24188) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007221) |
| 225100000X Physical Therapist (Licence: NY 043061) | |
| 225100000X Physical Therapist (Licence: MS pt6340) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2020-03-23 |