| NPI | 1720761570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 40QA02192500) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP035073T) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-10-17 |