| NPI | 1760943294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27232) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040754) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |