| NPI | 1154823300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT872483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0427421) |
| Enumeration Date | 2018-03-04 |
| Last Update Date | 2019-08-09 |