| NPI | 1164981742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043010) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10071) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2023-07-19 |