| NPI | 1801400213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT030018) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046035) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2022-04-15 |