| NPI | 1053357756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 020036) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 020036) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-02-17 |