| NPI | 1033848304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 051823-01) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012090-01) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2024-04-17 |