| NPI | 1245691286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044467) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT293258) |
| 225100000X Physical Therapist (Licence: MD 25854) | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2021-09-16 |