| NPI | 1720511546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041692-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3443) |
| Enumeration Date | 2017-04-08 |
| Last Update Date | 2026-04-08 |