| NPI | 1720476245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 033901) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1253180) |
| 225100000X Physical Therapist (Licence: MD 25221) | |
| 225100000X Physical Therapist (Licence: VA 2305209005) | |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2021-04-14 |