| NPI | 1053984922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002153) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048020) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2023-07-31 |