| NPI | 1427294875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24718) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 8524) |
| 225100000X Physical Therapist (Licence: NY 030964-1) | |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2025-01-30 |