| NPI | 1679189344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028949) |
| Enumeration Date | 2020-09-18 |
| Last Update Date | 2020-11-15 |