| NPI | 1861219594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052831) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 228822) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-09-24 |