| NPI | 1508348814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19141) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043247) |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2022-06-15 |