| NPI | 1316935141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 017265-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 0172651) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2019-05-15 |