| NPI | 1588961619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 13801) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032113) |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2021-07-06 |