| NPI | 1669854188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048679) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MD 25495) | |
| 225100000X Physical Therapist (Licence: CA PT296163) | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2022-07-20 |