| NPI | 1700486362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 046366-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046366) |
| Enumeration Date | 2020-10-31 |
| Last Update Date | 2021-05-19 |