| NPI | 1942928361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 13949) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049293) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2023-08-31 |