| NPI | 1629627740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37122) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044900) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2021-08-25 |