| NPI | 1366083784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045290) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P102844) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2024-05-01 |