| NPI | 1316424369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045366) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 11794) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2023-08-29 |