| NPI | 1578664256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 12342) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 15663) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2024-05-22 |