| NPI | 1528424413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211790) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039764) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2020-02-17 |