| NPI | 1942958418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4835) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048534-01) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-08-30 |