| NPI | 1518723097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 305668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042202-01) |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-02-22 |