| NPI | 1093957342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 267336) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 011915) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2023-03-14 |