| NPI | 1700312741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 25230) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT025930) |
| 225100000X Physical Therapist (Licence: MD 26078) | |
| 225100000X Physical Therapist (Licence: NY 041474) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2019-05-22 |