| NPI | 1568079242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046094) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046094-01) |
| Enumeration Date | 2020-09-28 |
| Last Update Date | 2025-05-14 |