| NPI | 1649438458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030294) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6684) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2021-05-10 |