| NPI | 1770056988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043905) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27436) |
| 225100000X Physical Therapist (Licence: DE J1-0004021) | |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2020-02-18 |