| NPI | 1952694952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: NY 030649) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030649) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2023-01-12 |