| NPI | 1891569323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050694) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30228) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-11-20 |