| NPI | 1649795212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27123) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 124371) |
| 225100000X Physical Therapist (Licence: NY 042198) | |
| Enumeration Date | 2017-08-04 |
| Last Update Date | 2022-07-21 |