| NPI | 1497937056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 012945-01) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 012945) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2025-06-19 |