| NPI | 1780818757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24463) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 027803-1) |
| Enumeration Date | 2009-05-06 |
| Last Update Date | 2021-10-02 |