| NPI | 1063059608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045087) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30042) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2024-08-02 |