| NPI | 1013316702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041423) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 21206) |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2025-06-20 |