| NPI | 1104446079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 2088932) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-04-21 |
| Last Update Date | 2025-01-02 |