| NPI | 1881027787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037761) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9889) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2020-11-20 |