| NPI | 1417326067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 009363) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047656) |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2021-10-26 |