| NPI | 1104996172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018577-01) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 018577) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2025-04-09 |