| NPI | 1881286714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046916-01) |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2021-06-06 |