| NPI | 1992175566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038368-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209885) |
| Enumeration Date | 2015-09-25 |
| Last Update Date | 2018-08-30 |