| NPI | 1194775247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 016390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 34468) |
| 225100000X Physical Therapist (Licence: UT 11032834-2401) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-10-03 |