| NPI | 1619423340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045849) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12396) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2021-04-09 |