| NPI | 1922511773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63042) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042523) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2018-11-15 |