| NPI | 1720088073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 023035) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0230351) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2017-02-08 |