| NPI | 1053480210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025370-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305205377) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2024-11-20 |