| NPI | 1477075307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041695) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP018443T) |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2023-03-10 |