| NPI | 1962174722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047919) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 047919) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2021-10-08 |