| NPI | 1619516226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045034-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14185) |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2023-09-13 |