| NPI | 1659972826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046411) |
| Enumeration Date | 2020-11-04 |
| Last Update Date | 2022-06-02 |