| NPI | 1881324127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 051204) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: VA 2305215120) | |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: OH PT019942) | |
| Enumeration Date | 2022-06-10 |
| Last Update Date | 2023-08-25 |