| NPI | 1184221533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050475) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT028854) |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2023-05-31 |