| NPI | 1174999510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002228) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28068) |
| 225100000X Physical Therapist (Licence: NY 039011) | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2023-01-10 |