| NPI | 1871103424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT210002339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044412) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2023-08-11 |