| NPI | 1023194768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025953-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 025953) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2024-02-07 |