| NPI | 1902887334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT5570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 022079) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2024-03-03 |