| NPI | 1720634959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050599) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT35048) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2024-03-18 |