| NPI | 1053971119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT38543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040796) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2024-06-18 |