| NPI | 1144453986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12599) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031804-1) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2023-12-29 |