| NPI | 1134664014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043498) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 010751-1) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2020-03-03 |