| NPI | 1336869742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P23351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT41183) |
| 225100000X Physical Therapist (Licence: NY 049257-01) | |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-08-05 |