| NPI | 1801929054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT29391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027324) |
| 225100000X Physical Therapist (Licence: IL 070015070) | |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2020-06-11 |