| NPI | 1114565983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043987) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11939) |
| Enumeration Date | 2019-12-12 |
| Last Update Date | 2019-12-12 |