| NPI | 1528044013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0269451) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2022-10-10 |