| NPI | 1427816842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 051341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0513u1) |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2024-03-20 |