| NPI | 1962827568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4428) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037034-1) |
| 225100000X Physical Therapist (Licence: NC 14701) | |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2023-08-02 |