| NPI | 1669849030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P17624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039005) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2022-05-13 |