| NPI | 1497517619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12609) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 052386) |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2024-12-03 |