| NPI | 1376928523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0395241) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8262) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2022-07-21 |