| NPI | 1336545326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209186) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038357) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2021-06-03 |