| NPI | 1598158297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 011730) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 011730) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2021-03-19 |