| NPI | 1124371398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 035860) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P86170) |
| 225100000X Physical Therapist (Licence: FL PT28647) | |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2023-11-03 |