| NPI | 1710585989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P100307E) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044159) |
| Enumeration Date | 2020-10-11 |
| Last Update Date | 2022-01-03 |