| NPI | 1861039620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030958) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| Enumeration Date | 2019-11-28 |
| Last Update Date | 2022-04-06 |