| NPI | 1609360189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 34533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036119) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2020-01-22 |