| NPI | 1750835351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01999900) |
| 225100000X Physical Therapist (Licence: CA 297922) | |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2023-12-21 |