| NPI | 1235564824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014183) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: NY 014183) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2021-04-13 |