| NPI | 1184137994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215835) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041752) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2023-06-11 |