| NPI | 1124674155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047020) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2021-03-15 |