| NPI | 1235597824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209975) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25837) |
| 225100000X Physical Therapist (Licence: NY 039812) | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2021-09-03 |