| NPI | 1124541537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10325) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040635) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2023-01-09 |