| NPI | 1336624220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 043568-1) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2020-11-25 |