| NPI | 1902464498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044985) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305212653) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305212653) | |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2022-10-30 |