| NPI | 1619492865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041656) |
| Additional Taxonomies | 2085N0904X (Licence: MD 26845) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD 26845) | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2025-04-23 |