| NPI | 1770893877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NY 023706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033116) |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2019-08-05 |