| NPI | 1417159088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 026231) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 026231-1) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2020-12-09 |