| NPI | 1518219369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12603) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034464) |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2024-05-09 |