| NPI | 1437848207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 13773) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 13773) |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2023-07-12 |