| NPI | 1881692309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 016861-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020550) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2020-05-07 |