| NPI | 1114691227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050017) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012938) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2023-03-10 |