| NPI | 1043981053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052206) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ LPT-32001) |
| Enumeration Date | 2021-09-21 |
| Last Update Date | 2024-04-22 |