| NPI | 1639889215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 01357301) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 04152601) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-05 |