| NPI | 1912449547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041494-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10003243) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2022-11-08 |