| NPI | 1457885295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038891) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic |
| 2251N0400X Physical Therapist, Neurology | |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2019-05-08 |