| NPI | 1083169510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040364) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2021-08-12 |