| NPI | 1164150314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049024) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2023-10-19 |