| NPI | 1437531605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042991) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015020279) |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2019-05-19 |