| NPI | 1922157460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007600) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026331) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2021-10-28 |