| NPI | 1720231806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205824) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025113) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2024-09-25 |