| NPI | 1932349222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13041) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020180-1) |
| Enumeration Date | 2009-02-25 |
| Last Update Date | 2022-03-23 |