| NPI | 1568977577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041649-1) |
| 225100000X Physical Therapist (Licence: SC 10013) | |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2023-03-20 |