| NPI | 1053890772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 300139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040321) |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2022-06-10 |