| NPI | 1063968519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P20013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11140) |
| 225100000X Physical Therapist (Licence: NY 042677) | |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2024-01-19 |