| NPI | 1992344477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046478) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P16555) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2021-08-02 |