| NPI | 1093285181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM PT5603) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043668) |
| Enumeration Date | 2018-11-30 |
| Last Update Date | 2023-07-12 |