| NPI | 1679098149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT32854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042877) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2019-12-09 |