| NPI | 1043485725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032963-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 08308) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2021-09-01 |