| NPI | 1316609605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42373) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047756) |
| Enumeration Date | 2021-10-13 |
| Last Update Date | 2024-10-29 |