| NPI | 1417956392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 9306) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 012988) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2024-06-06 |