| NPI | 1144878497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044661) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2021-07-26 |