| NPI | 1770124489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 011922) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2019-10-17 |