| NPI | 1255845509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042382-1) |
| Enumeration Date | 2017-11-23 |
| Last Update Date | 2021-03-24 |