| NPI | 1265089189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0016929) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044703) |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2024-10-29 |