| NPI | 1104877422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027084) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NY 027084) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-06-10 |