| NPI | 1083193577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043159) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P10379) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-13 |