| NPI | 1982826996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0292391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 9079) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2021-04-12 |