| NPI | 1457089948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39186) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050280) |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2023-06-07 |