| NPI | 1871979716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040282-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P98435) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2025-05-19 |