| NPI | 1932444783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 033617) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: NY 016278-1) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2024-05-20 |