NPI | 1902995012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 4629) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0030771) |
Enumeration Date | 2006-10-12 |
Last Update Date | 2025-09-11 |