| NPI | 1053636571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032422) |
| Enumeration Date | 2010-03-29 |
| Last Update Date | 2022-04-20 |