| NPI | 1881064970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P22860) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039351) |
| Enumeration Date | 2015-10-01 |
| Last Update Date | 2024-03-01 |