| NPI | 1699963942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 029763) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62P60043) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2025-05-16 |