| NPI | 1205310885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043450) |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2023-07-24 |