| NPI | 1255862413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12382) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038688) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-11-05 |