| NPI | 1871903161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041595) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 008259) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2022-07-21 |