| NPI | 1861915191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041131) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211240) |
| 225100000X Physical Therapist (Licence: MD 26550) | |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2017-07-18 |