| NPI | 1053781518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62039450) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025737) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2021-03-29 |