| NPI | 1457685745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18398) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031807-1) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2021-02-26 |