| NPI | 1982934436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 009169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031787) |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2023-04-22 |