| NPI | 1073615639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12576) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020256) |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2025-01-06 |