| NPI | 1487636544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027088) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027088-1) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2022-06-02 |