| NPI | 1548807480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 5925) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045309) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2020-10-13 |