| NPI | 1083293724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT41855) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046595) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2024-09-02 |