| NPI | 1508806803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 021728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 021728-1) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-02-09 |