| NPI | 1629662960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 2440) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046368) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2021-02-26 |