| NPI | 1982387601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 051703) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 013668-01) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2023-11-17 |