| NPI | 1346073111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052886) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 052886-01) |
| Enumeration Date | 2024-08-26 |
| Last Update Date | 2025-05-21 |