| NPI | 1033789441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014874) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 014874) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2021-06-28 |