| NPI | 1518401744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037321) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 037321-1) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2019-06-28 |