| NPI | 1952862435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 049268) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| 225200000X Physical Therapy Assistant (Licence: NY 011627) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-03-02 |