| NPI | 1821602178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046502) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1333741) |
| 225100000X Physical Therapist (Licence: NC P20003) | |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2024-12-12 |