| NPI | 1568995702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29263) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044940) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 003194) | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2024-10-22 |