| NPI | 1104337088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041975) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2024-01-02 |