| NPI | 1619539053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 023420) |
| 225100000X Physical Therapist (Licence: IN 05013119A) | |
| Enumeration Date | 2019-07-06 |
| Last Update Date | 2019-07-06 |