| NPI | 1912070285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 2681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 015101-1) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2020-07-27 |