| NPI | 1740889112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4382) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045962) |
| Enumeration Date | 2020-10-18 |
| Last Update Date | 2020-10-18 |