| NPI | 1750950754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047355) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4813) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-07-06 |