| NPI | 1801534540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042947) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 013258) |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-05-23 |