| NPI | 1134593569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 16097) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034916) |
| Enumeration Date | 2015-11-23 |
| Last Update Date | 2020-12-18 |