| NPI | 1497992812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0592919) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: PA DAPT002414) |
| 225100000X Physical Therapist (Licence: PA PT007941L) | |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2021-04-23 |