NPI | 1336690361 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: NY 040332) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040332) |
Enumeration Date | 2016-10-14 |
Last Update Date | 2025-03-22 |