| NPI | 1710319603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16454) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 036346) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2019-09-26 |