| NPI | 1134760416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048948) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE012300) |
| Enumeration Date | 2019-10-08 |
| Last Update Date | 2022-08-11 |