| NPI | 1194170589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045014-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 43485) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2024-03-26 |