| NPI | 1437488780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT31443) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031479-1) |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2021-01-29 |