| NPI | 1609190453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032507-1) |
| Enumeration Date | 2010-03-23 |
| Last Update Date | 2020-03-31 |