| NPI | 1255921821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 146774) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-01-21 |