| NPI | 1487021325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16022) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039156-1) |
| Enumeration Date | 2015-08-26 |
| Last Update Date | 2018-08-23 |