| NPI | 1629662705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045869) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 012779) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-01 |