| NPI | 1114981784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 039400-01) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 2799) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2024-10-11 |