| NPI | 1629491774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036421-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-05129) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2018-11-21 |