| NPI | 1295108090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17497) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039525-1) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2021-02-24 |